NPIMap

Organization Active NPI

Providence Network

  • Addiction (Substance Use Disorder) Counselor
  • Denver, CO
National Provider Identifier
1841059664
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
PROVIDENCE NETWORK
Practice address
2544 Champa St
Denver, CO 80205-3700
Phone
(303) 744-3986
NPI assigned
Mar 14, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Derek Kuykendall
Title
Executive Director
Phone
(303) 860-8484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

2544 Champa St
Denver, CO 80205-3700

Mailing address

801 N Logan St
Denver, CO 80203-3114
Phone (303) 744-3986

Other names 1

  • The Executive Network Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Providence Network6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1841059664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N LOGAN ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802033114",
            "telephone_number": "303-744-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2544 CHAMPA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802053700",
            "telephone_number": "303-744-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "KUYKENDALL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "303-860-8484"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Executive Network",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.